Fireplace Measurements Form by Tri County Hearth

Name

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Customer Name

First Last

Email

Salesperson/Tech

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone

Home Phone

Cell Phone

Date

A. Width-Front

B. Width-Rear

C. Height-Center

D. Height-Side

E. Firebox Depth

F. Hearth Measurement

G. Distance to Side Mantle Left (or combustible surface)

H. Height to Mantle (or combustible surface)

J. Distance to Side Mantle Right (or combustible surface)

K. Width of Lintel

Is this an arch fireplace?

Yes
No

Is this a prefabricated or all metal fireplace?

Yes
No

Is this an all masonry fireplace?

Yes
No

Is there a drop between the hearth and the firebox?

Yes
No

How much?

Please note any unusual protruding bricks.

Is there anything unusual about the fireplace?

Yes
No

Type of Facing:

Brick
Stone

Is a flue liner in chimney?

Yes
No

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Fireplace Measurements Form

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2475 Old Washington Rd.
Waldorf, MD 20601

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